AccountId: 011433970860
ContactId: efeb5d15-e45c-4aa7-8abb-fb25106ef93c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 305369 ms
Total Talk Time (AGENT): 106950 ms
Total Talk Time (CUSTOMER): 102410 ms
Interruptions: 2
Overall Sentiment: AGENT=0.6, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/05/efeb5d15-e45c-4aa7-8abb-fb25106ef93c_20250605T16:10_UTC.wav
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[AGENT][NEUTRAL] Calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi [PII]. This is May. I need assistance from the I claim.
[AGENT][NEUTRAL] Sure, [PII], I can assist you with that. Are you a member or a provider?
[CUSTOMER][NEUTRAL] Provider.
[AGENT][NEUTRAL] Can I have the spelling of your name and a callback number?
[CUSTOMER][NEUTRAL] Yes, it's [PII]. The callback number is [PII].
[AGENT][NEUTRAL] And could you repeat the spelling of your name again?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes. Yes.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] What is that policy number of the member that you're calling to verify eligibility for today? What claim status?
[CUSTOMER][NEUTRAL] Um, one second.
[CUSTOMER][NEUTRAL] Uh, can you check with the first name and last name?
[AGENT][NEUTRAL] Do you have a social?
[CUSTOMER][NEUTRAL] Uh, one sec, I found the member ID 26064.
[AGENT][NEUTRAL] That's not a policy number. Do you have the member's social or copy of the card?
[AGENT][NEUTRAL] Should say policy or certain number listed on the card?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Um, yeah, sure. One sec.
[CUSTOMER][NEUTRAL] The full social security number you need or the last four digits?
[AGENT][NEUTRAL] Yes, the 49 digits.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And what is this member's name?
[CUSTOMER][NEUTRAL] The patient is [PII]. Date of birth [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] So let me know when you're ready for the correct policy number.
[CUSTOMER][NEUTRAL] OK. Go ahead.
[AGENT][NEUTRAL] It is 2,404,600. That's 2,404,600.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is the date of service that you're calling to check the status of a claim for?
[CUSTOMER][NEUTRAL] Uh, [PII] and the bill amount $1,215.
[AGENT][NEUTRAL] [PII], so it looks like this claim was submitted twice the first time it was submitted and denied as office visits are not covered under the policy because the policy does not cover office visits.
[CUSTOMER][NEUTRAL] OK. Uh, what is the type of the plan?
[AGENT][NEUTRAL] Then the 2nd time it was submitted.
[AGENT][NEUTRAL] And then it was submitted as a duplicate.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, one second.
[AGENT][NEUTRAL] And the claim was received [PII]. It was processed [PII].
[CUSTOMER][NEUTRAL] What type of
[CUSTOMER][NEUTRAL] OK. What type of policy is this?
[AGENT][NEUTRAL] This is a gap insurance that assists with deductible, co-pay and co-insurance for services covered under the policy.
[CUSTOMER][NEUTRAL] OK. Can you give me the plan name? What is the full plan name?
[AGENT][NEUTRAL] This is a Medin policy.
[CUSTOMER][NEUTRAL] Ming gap policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So the office visit not covered. Any office visit, maybe specialist and uh physician.
[AGENT][NEUTRAL] Yes, that is correct. That is correct. Any office visits office visits is just not covered under the policy.
[CUSTOMER][POSITIVE] Oh, thank you so much. Please give um give me the reference number for our call.
[AGENT][NEUTRAL] We don't provide reference numbers. However, [PII], you can use my name and today's date as a reference is S as in [PII] in today's date.
[CUSTOMER][POSITIVE] OK. Thank you, [PII], for your help. I want.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL. You have a great one as well. Goodbye.
[CUSTOMER][NEUTRAL] Bye-bye.